Qualitative Study In England Research Articles

Perceptions and attitudes of patients towards medication-related osteonecrosis of the jaw (MRONJ): a qualitative study in England

ObjectiveTo explore the impact of medication-related osteonecrosis of the jaw (MRONJ) on quality of life and to explore the attitudes and perceptions of patients towards the multidisciplinary approach to the...

Barriers to cervical screening among older women from hard-to-reach groups: a qualitative study in England

BackgroundCervical screening attendance among 50–64 year-olds is suboptimal. Understanding attitudes to screening and reasons for non-attendance in older women will help to identify the content of interventions for this age group. This study aimed to explore barriers to cervical screening among women aged 50–64 years from hard-to-reach groups whose perspectives are often absent from research on cervical screening but are critical to developing appropriate interventions to increase engagement with the screening offer.MethodsQualitative methodology was used. Six focus groups were carried out with women aged 50–64 years from lower socio-economic and ethnic minority backgrounds (n = 38). Focus group discussions were recorded, transcribed verbatim and translated where necessary. Data were analysed using the Framework Approach, a type of thematic analysis.ResultsAll women had heard of cervical screening, but many felt they had poor knowledge. Women’s reasons for non-attendance were wide-ranging and included discomfort and embarrassment, negative perceptions of health professionals, worry and trust in the results, concern about the procedure, idiosyncratic beliefs, and extreme negative experiences. Some women reported not receiving letters or prompts to be screened.ConclusionsInformation designed specifically for older women should ensure they understand the purpose of screening and its relevance to them. Emphasising changes to the programme that have made the experience less uncomfortable, and improved sample taker awareness of how women feel, may help to allay concerns related to previous negative experiences.

Engaging hard-to-reach groups in health promotion: the views of older people and professionals from a qualitative study in England

BackgroundOlder people living in deprived areas, from black and minority ethnic groups, and aged over 85 years are often considered hard-to-reach. This qualitative study aimed to explore their views on health promotion services, with a view to help inform best practice on engagement. MethodsOlder people were recruited through primary care and community-based groups. 19 participated in an interview (n=15) or focus group (n=4); including some overlaps, 16 were from a deprived area, 12 were in black and ethnic minority groups, and 5 were aged 85 years or older. Cross-sector professionals across England with experience of working with one or more of the groups were identified with online searches and snowball sampling. 31 of 44 professionals completed an online survey. Thematic analysis was used to develop a framework of higher and lower level themes. Interpretations were discussed and agreed within the team. FindingsOlder people from all hard-to-reach groups described some health-promoting activities they practised themselves, including lifelong lifestyle approaches, with a focus on maintaining independence. All groups reported cost and access considerations as barriers to participation in health promotion. Among older people in deprived areas, facilitators included monetary incentives and interventions held locally or accessible through free transport. Barriers included reluctance to seek medical help, mistrust of professionals, and negative social relationships with other participants. Professionals' successful strategies targeting this group included personalised health education focusing on their interests and engaging local services, community, peers, and family. Older people from black and ethnic minority groups reported that social opportunities and peer support facilitated engagement. Barriers focused on cultural and language differences. These barriers were also reported by professionals who reported culture-specific, tailored information alongside good relationships with community groups and families as important. For the oldest-old, home visits were popular. Poor health and lack of interest in health promotion were major barriers. Face-to-face contact and involving individuals from an early stage were reported as successful strategies by professionals. InterpretationThis is one of few studies conducted in England investigating views of both hard-to-reach older people and professionals working with them. Study limitations include selection bias because only those interested responded. Specific facilitators and barriers identified by older people and professionals may shape best practice on increasing engagement with health promotion services for hard-to-reach groups. FundingNational Institute for Health Research (NIHR). AL is funded by the NIHR School for Public Health Research.

Domestic labour, masculinity and social change: insights from working-class young men’s transitions to adulthood

Drawing on a seven-year longitudinal qualitative study in England, this paper presents evidence of how engagement with housework and childcare is regular and normalized for contemporary working-class young adult men. I explain this development with reference to inclusive masculinity theory, but supplement this by incorporating Mannheim’s concept of social generation, as recently adopted by scholars of youth sociology. The paper thus further augments other research that has documented considerable change in the construction and performance of contemporary masculinities – such as an opening up of gendered behaviours and a decrease (but not erasure) of homophobia – among young men across multiple contexts in English-speaking countries.

Adult patients\u2019 experiences of NHS specialist services for chronic fatigue syndrome (CFS/ME): a qualitative study in England

BackgroundFew studies have explored patients’ experiences of treatment for CFS/ME. This study aims to fill this gap by capturing the perspective of patients who have been treated by NHS specialist CFS/ME services in England.MethodsSemi-structured interviews were conducted during the period June–September 2014 with 16 adults who were completing treatment at one of three outpatient NHS specialist CFS/ME services. Interviews were analysed thematically using constant comparison techniques, with particular attention paid to contrasting views.ResultsThree themes were identified: ‘Journey to specialist services’; ‘Things that help or hinder treatment’; and ‘Support systems’. Within these themes nine sub-themes were identified. A wide range of factors was evident in forming participants’ experiences, including personal characteristics such as perseverance and optimism, and service factors such as flexibility and positive, supportive relationships with clinicians. Participants described how specialist services played a unique role, which was related to the contested nature of the condition. Many participants had experienced a lack of validation and medical and social support before attending a specialist service. Patients’ experiences of life before referral, and the concerns that they expressed about being discharged, highlighted the hardship and obstacles which people living with CFS/ME continue to experience in our society.ConclusionsThe experiences of CFS/ME patients in our study showed that NHS specialist CFS/ME services played a vital role in patients’ journeys towards an improved quality of life. This improvement came about through a process which included validation of patients’ experiences, acceptance of change, practical advice and support, and therapeutic outcomes.

What do older people experiencing loneliness think about primary care or community based interventions to reduce loneliness? A qualitative study in England.

Loneliness in later life is a common problem with poor health outcomes. However, interventions to prevent or ameliorate loneliness have a weak evidence base. The views of older people experiencing or at risk of loneliness in the community are important in identifying features of potential support, but have been little studied. Twenty‐eight community dwelling people, aged 65 and over who reported being ‘lonely much of the time’ or identified as lonely from the de Jong Gierveld six‐item loneliness scale in a larger study, participated in in‐depth interviews, between June 2013 and May 2014. Views and experiences on seeking support from primary care and community based one‐to‐one and group based activities, including social and shared interest groups, were explored. Interviews were recorded and transcribed. Thematic analysis was conducted by a multidisciplinary team, including older people. Using two different measures of loneliness enabled a spectrum of loneliness experience to be explored. Two‐thirds of the participants were the ‘younger old’ and all were able to leave their homes independently. Older people with characteristics of loneliness were generally knowledgeable about local social and community resources but, for the majority, community and primary care based services for their loneliness were not considered desirable or helpful at this point in their lives. However, group based activities with a shared interest were thought preferable to one‐to‐one support (befriending) or groups with a social focus. Descriptions of support as being for loneliness and specific to older people discouraged engagement. Older people experiencing or at risk of loneliness did not consider that primary care has a role in alleviating loneliness because it is not an illness. They thought primary care practitioners lack understanding of non‐physical problems and that a good relationship was necessary to discuss sensitive issues like loneliness. For many, loneliness was a complex and private matter that they wished to manage without external support.

Paramedics' views on their seizure management learning needs: a qualitative study in England

IntroductionThe UK ambulance service often attends to suspected seizures. Most persons attended to will not require the facilities of a hospital emergency department (ED) and so should be managed at...

Newspaper reporting of homicide-suicide and mental illness.

Aims and methodTo explore the portrayal of homicide-suicide in newspaper articles, particularly how mental illness was reported. We carried out a qualitative study in England and Wales (2006-2008). Data from newspaper articles obtained via the LexisNexis database were used to examine a consecutive series of 60 cases.ResultsA fascination with extreme violence, vulnerable victims and having someone to blame made homicide-suicides newsworthy. Some offenders were portrayed in a stereotypical manner and pejorative language was used to describe mental illness. The findings showed evidence of inaccurate and speculative reference to mental disorder in newspaper reports.Clinical implicationsThe media should avoid speculation on people's mental state. Accurate reporting is essential to reduce stigma of mental illness, which may in turn encourage people to seek help if they experience similar emotional distress.

Describing interruptions, multi-tasking and task-switching in community pharmacy: a qualitative study in England.

There is growing evidence around interruptions, multi-tasking and task-switching in the community pharmacy setting. There is also evidence to suggest some of these practices may be associated with dispensing errors. Up to date, qualitative research on this subject is limited. To explore interruptions, multi-tasking and task-switching in the community setting; utilising an ethnographic approach to provide a detailed description of the circumstances surrounding such practices.Setting Community pharmacies in England, July-October 2011. An ethnographic approach was taken. Non participant, unstructured observations were utilised to make records of pharmacists' every activity. Case studies were formed by combining field notes with detailed information on pharmacists and their respective pharmacy businesses. Content analysis was undertaken both manually and electronically, using NVivo 10. Main outcome measure To determine the factors influencing interruptions, multitasking and task-switching in the community pharmacy setting. Response rate was 12 % (n = 11). Over fifteen days, a total of 123 h and 58 min of observations were recorded in 11 separate pharmacies of 11 individual pharmacists. The sample was evenly split by gender (female n = 6; male n = 5) and pharmacy ownership (independent n = 5; multiple n = 6). Employment statuses included employee pharmacists (n = 6), owners (n = 4) and a locum (n = 1). Average period of registration as a pharmacist was 19 years (range 5-39 years). Average prescription busyness of pharmacies ranged from 2600 to 24,000 items dispensed per month. All observed pharmacists' work was dominated by interruptions, task-switches, distractions and multi-tasking, often to manage a barrage of conflicting demands. These practices were observed to be part of a deep-rooted culture in the community setting. In particular, support staff regularly contributed to interruptions and distractions for pharmacists; pharmacists in turn continued to permit these. Novel directional work maps illustrated the extent and direction of task-switching and multi-tasking employed by pharmacists. In this study pharmacists' working practices were permeated by interruptions, distractions and multi-tasking. Task-switching was also frequently employed by pharmacists. Changes to working practices by both pharmacists and support staff would help to minimise these which in turn has the potential to lead to safer and more efficient methods of working.

Care workers in long-term care for older people: challenges of quantity and quality

This article, drawing on a qualitative study in England, the Netherlands and Taiwan, explores how countries with very different care systems address the challenge of securing sufficient numbers of care workers with appropriate skills in ageing care. The analysis exposes the salient features of care systems, ageing-care markets and the ageing-care workforce in the three countries. To support the analysis, examples of how the countries attempt to recruit and retain ageing-care workers are provided. Key findings are that to secure an adequate number of skilled ageing-care workers, job satisfaction, coherence between care and labour policies and equal working conditions across sectors are vital. A quality ageing-care worker requires regular professional supervision and support, resources for ongoing training and career development opportunities. Most importantly, securing a sufficient number of ageing-care workers and ensuring they have appropriate skills are not isolated challenges but are interlinked and require collaboration between a range of care actors.

Facilitating decision-making by people with dementia: is spousal support gendered?

The Mental Capacity Act 2005 clarifies the decision-making rights of people lacking capacity (such as people with dementia) and requires that carers and professionals support the individual in making decisions. This paper reports key findings from a qualitative study in England which examined the social process of everyday decision-making by couples living with dementia. The author identifies the various support strategies used by spouses when seeking to facilitate decision-making by their partners with dementia and highlights how these varied by gender. The paper examines the role of gendered support in influencing whether people with dementia are enabled to exercise their decision-making capacity and, in turn, if their decisional autonomy is facilitated. As the Mental Capacity Act lacks a gender perspective, the author recommends that its ongoing implementation should be strongly gendered to ensure that women with dementia receive the support necessary to exercise their capacity and agency.

‘Can't cook, won't cook’: men's involvement in cooking when their wives develop dementia

The division of household labour in heterosexual couples continues to be unequal, indicating that gender inequality persists in the domestic sphere. Yet, although there is a lack of gender equity in housework, this is less clear-cut in terms of cooking. This paper explores whether men are willing to cook when their wives develop dementia. The paper presents findings from a qualitative study in England (funded by the Economic and Social Research Council (ESRC)), which explored the everyday decisions made by married couples when one partner had dementia. The author examines the division of labour within the couples and identifies whether women exercised choice and control over who did the cooking. Although research into dementia usually focuses on the social competence of people with dementia (as determined by their carers), this study explored the domestic competence of both spouses, particularly husbands who were carers. It was found that men are often unable or unwilling to cook when their wives develop dementia or, alternatively, they take over cooking altogether, thereby excluding their wives from a task they enjoy. Gendered patterns of authority or control were apparent in the couples' decision-making dynamics, indicating that gender inequality in relationships persists even when women develop dementia.

Still a woman’s job: the division of housework in couples living with dementia

Progress towards gender equality within intimate relationships has been slow, evident in the persistent unequal division of household labour. Previous studies have primarily focused on non-disabled couples, but research into couples where women were physically disabled has similarly shown a lack of gender equity in housework. However, there was a gap in the evidence in relation to whether men do more housework when women develop dementia. This article presents findings from a qualitative study in England, which explored the everyday decisions made by married couples where one partner had dementia. The author examines the division of labour within the couples and identifies whether women exercised any control over who did the housework. As it was found that men were often reluctant to undertake housework when their wives developed dementia, the author concludes that gender inequality in domestic labour tends to persist, irrespective of cognitive disability.

The needs of carers of men with prostate cancer and barriers and enablers to meeting them: a qualitative study in England

The aim of this study was to explore the needs of carers of men with prostate cancer and to identify barriers and enablers to meeting these needs. Carers were recruited to focus groups or interviews. These were recorded, transcribed and analysed by two researchers using Nvivo QSR6 and the Framework approach to index, chart and analyse data to identify emergent themes of the needs of carers, and barriers and enablers to meeting these needs. Fifteen carers took part in focus groups and 19 were interviewed. Carers' needs varied and were often unmet because of barriers to existing services. Carers needed: information; emotional support; practical support; effective medical care for the patient. Barriers to carers meeting their needs included: lack of awareness of sources of help; lack of understanding of information; reluctance to ask for help; prioritising the patient's needs. Enablers included better signposting to information and sources of support, and assessment of their needs. Interventions to address these needs should be developed taking account of the barriers and enablers identified here, and the experience of reported interventions for carers of other cancer patients. Carers should be offered an assessment to establish their needs and directed to appropriate sources of help.

P-876 - Adult adhd patients’ experiences of impairment, accessing services and treatment management - a qualitative study in England

There is limited understanding of the health and treatment-related experiences of adults with Attention Deficit Hyperactivity Disorder in England. To explore the experiences of adults with ADHD regarding impairment, accessing diagnostic and treatment services, and to compare experiences between patients diagnosed during adulthood and childhood. Semi-structured face-to-face interviews were conducted with 30 adults with ADHD, recruited across England. Half of the participants were diagnosed during childhood and the remainder during adulthood. Data was analysed using Thematic Analysis and data saturation was achieved. Getting a diagnosis and accessing ADHD services in adulthood was an ‘ uphill struggle ’, often due to negative and sceptical attitudes towards ADHD by healthcare professionals. Many patients struggled for years with misdiagnoses of depression and anxiety, and severe difficulties accessing care and treatment caused a downward spiral into functional impairment in some. Accumulated psychosocial burden was evident as living with undiagnosed ADHD had resulted in a chronic sense of failure and missed potential in many diagnosed from late adolescence onwards. Positive adjustment was facilitated by a younger age at diagnosis. Although medication was perceived as necessary in alleviating impairment, many deemed pharmacological treatment by itself as inadequate. Additional support, especially psychological therapies/psycho-education was strongly desired, yet few patients had access to non-pharmacological treatment. This study suggests that the unmet needs of adults with ADHD are substantial, particularly in those diagnosed from late adolescence onwards. The findings suggest there is a wide gap between policy and practice in England.

Peer regulation of teenage sexual identities

This article examines the teenage policing of heterosexuality in schools and contributes to debates about teenage sexual moralities and heterosexual male agency. It reports on a qualitative study in England of the collective sexual values of 12‐ to 13‐year‐olds and 14‐ to 15‐year‐olds. Focus group interviews indicated that pupils developed a consensual sexual morality through collusive sex talk. Homophobic and misogynistic views and verbal abuse were found to be key instruments of teenage peer regulation of sexual identities crossing class and ethnic boundaries. We found that the ‘official’ discourse of sex education did not relate to teenage lives. Anxieties about heterosexual masculinity and girls' sexual agency were conveyed by some boys through verbal sexual harassment—a form of behaviour regarded as intimidating yet normal. While white and Asian boys were more conservative in their views about marriage than girls, white and Asian girls struggled to resist heterosexual masculine power through career aspirations, by questioning marriage and being informed about sexual issues.